Process - Physician - Fraser Health Authority

3. Gather details on current andprevious attemptsPrevious attempts, especially inpast year = HIGHER RISKTriggers of Present AttemptWalk me through the last 24 hours. At what point did youconsider suicide?Triggers of Past AttemptsTell me about other times you have seriously consideredsuicide or made an attempt. What chain of events led upto attempts you’ve made in the past?LethalityAssess the lethality of the method(s). What was thelikelihood that the patient would be found after they madethe attempt?ImpulsivityWas attempt carried out in the heat of anger (impulsive) orwas it carefully thought-out (planned), with day and timepicked in advance? What was the direction of hostility (goalto hurt self or others)?IntoxicationWas patient intoxicated at time of attempt (substance usecan lead to disinhibition and can contribute to individualsacting in atypical ways)?Expectations of DyingWhat did you think would happen to you when you [cut yourwrists/took an overdose]? How did you think others wouldrespond? Did you truly think you would die?OutcomeWas medical intervention required? How was this accessed(e.g., patient called for help vs. being found unresponsive byothers)?4. Obtain information on psychiatricand other historyObtain information on psychiatric history (e.g., depression,psychosis), including symptoms that may suggestundiagnosed mental illness; substance use/abuse (alcohol,drugs); and past/current mental health treatment, includingall current and past psychiatric medications.Obtain information on other chronic and acute stressors(e.g., loss of relationship, loved one, job; gambling/financialstressors; trauma/abuse; struggle with sexual identity issues;changes/discontinuation of medications).Assess for protective factors, such as family, friends, pets,religion, and therapist.Ask about any other relevant and contributory factors.Is there anything else I should know about?5. Conduct mental status examinationEmotional StateWhat is the patient’s self-reported mood vs. their observedaffect?Extremes in emotional state/mood (no vitality,emotionally numb or unbearable emotionalpain/turmoil) = HIGHER RISKBehaviour & AppearanceHow is the patient behaving (agitated, alert, cooperative)?How do they appear (hygiene, speech)?Thought ProcessIs the patient oriented? Are attention, concentration andmemory intact? Assess thought process (logical, organized),thought content (paranoid, delusional), and judgment andreasoning.Feelings about SurvivalGuilt, remorse, embarrassment = LOWER RISKDisappointment, self-blame = HIGHER RISK(e.g., I couldn’t even get this right and kill myselfproperly)150